... In wondering why gp's don't even mention St. John's wort for depression?

[Minifingers]

Been feeling very tearful, weird sleep patterns, shouty, negative, hopeless for a few months now for reasons mostly to do with family strife. Recognised that I was tipping back into a depressed state similar to one I was in a few years ago. Went to gp and asked if she could prescribe me a low dose of an AD which wouldn't make me fat and make sex rubbish. She said 'no - they almost all do this to a lot of people, and gave me a prescription for sertraline.

Anyway, after reading up about the side effects and thinking about how horrible it is when you start taking AD's I started to feel very reluctant to take them. Decided instead on the recommendation of a friend to give St. John's wort a go instead after doing a bit of research on its safety and effectiveness. Seems that in Germany it's often prescribed by gps for mild/moderate depression in preference to SSRI's and is considered completely mainstream.

Anyway, low and behold it's worked really well - a week on I feel so much better. Much less tearful, just miles better.

Why don't gps even mention it to those of us who haven't got any specific health reasons not to use it and are not on other non-compatible meds?

I'm amazed by how effective it is - for me as good as fluoxetine which I used a few years ago for a few months when I was depressed. And no unpleasant side effects that I'm aware of (I'm staying out of the sun).

[Tulip26]

SJW didn't do a lot for my depression. Made me more sensitive during sex though, enjoyed that side effect.

[Minifingers]

Piscovas - it has been in use for hundreds of years, and prescribed in Germany for DECADES. Why is it ok to prescribe something we KNOW has rare but well documented severe side effects for those for whom it's believed to be suitable, but an alternative product which has been in use for decades and has been the subject of hundreds of clinical trials is considered more dangerous?

And of course people who are considering taking it should be advised as to whether it's suitable for them on the basis of their general health and any other medications they may be taking, but that's not going to happen if GPs refuse to discuss it!

[BumpyGrindy]

Mini you seem to be quite knowledgeable...can you advise me please? Would love to try something ....

[Minifingers]

"Made me more sensitive during sex though, enjoyed that side effect."

Thanks for that.

[Latara]

Oh. Sorry. I didn't think about copying and pasting.

But personally I'd still recommend the Sertraline... ok I admit it didn't work for me, Venlafaxine did but then I had severe depression.

[Iggity]

Those list of side effects for sertraline should be put into context. They are from both trials and usage in the general population. For the latter group, there is no denominator so have to be viewed cautiously. Shopping lists of adverse effects are useless for prescribers and patients.

[Ignaz]

Sertraline gave me no side-effects at all. Didn't give me any effects actually, which was a bit disappointing.

[FrozenNorthPole]

They don't recommend it because they would be putting themselves in a hugely vulnerable position to recommend a medicine that:

1. doesn't appear in the British National Formulary,
   
2. does not feature in NICE guidelines and so
   
3. might lead to their legal defence organisation refusing to represent them if the patient alledged that any harm was caused by the recommendation, regardless of whether any harm actually was caused.
   

Given that 17% of GPs will receive a complaint to the GMC each year* (and that includes the part-time ones so chances for full-time ones even higher), I can understand why doctors might be a little bit wary of wandering into the realm of unregulated herbal medicines.

But, you know, it's possible that they're just being typical lazy doctors by not mentioning SJW I suppose [sceptical]

* more complaints has not resulted in more sanctions i.e. a greater percentage of complaints are spurious year-on-year, it isn't that the medicine practiced is getting worse.

[Minifingers]

"All drugs have side-effects, even natural ones. They aren't necessarily better because they are natural."

Well... I don't think anyone is suggesting herbal remedies can't be dangerous or cause dangerous or unpleasant side effects.

[mousmous]

bumpy read up on the serious side effects (and the symptoms of them) first.

[Latara]

FrozenNorthPole is right. It's to do with research and NICE guidelines etc etc. I would have said the same but I couldn't explain it so well!

[puffylovett]

My gp did. But then, he also took one look at my monsters, asked me if I worked and then told me I didn't have pnd - just needed a break and a good nights kip

[Minifingers]

Mousmous - according to the Cochrane review of SJW it has significantly fewer side effects than SSRI's.

[NigellasDealer]

i have heard that the doctors in Germany routinely prescribe SJW for mild to moderate depression.

but GPs work from a 'list' of stuff they can and cannot prescribe, no idea who compiles the list or what the whys and wherefores of it are.

For example (nothing to do with depression) they cannot prescribe ivermectin although it is the most effective drug against scabies.

[Minifingers]

"i have heard that the doctors in Germany routinely prescribe SJW for mild to moderate depression"

Yes, they do.

Just feel the gp could have mentioned it. Didn't expect her to prescribe it.

[NigellasDealer]

sorry i see you already mentioned that minifiingers.
they will not mention anything that is not on the 'list'

[NigellasDealer]

and they are paid per prescription so it would not be in their interests to send you off with no prescription and the advice to get some SJW.
might go and get some next week now you mention it, it is good stuff.

[ouryve]

because it's very crude and can give you cataracts?

[NigellasDealer]

well compared to minifingers list of the side effects of setraline.....that's kind of short.

[ouryve]

www.ncbi.nlm.nih.gov/pubmed/19895314

[bunchoffives]

If you were worried about what was in a SJW tablet you could always try the fresh plant or visit a homeopath.

[leezl]

One particular AD won't work the same way for everyone. I've been prescribed a lot of different things in the past, but Sertraline is what is working for me at the moment. Incidentally it's considered one of the safest ADs to take during pregnancy (because it has had the most research conducted on it). All medications have side effects which many people will never experience.
Saying St Johns Wort is "as effective as fluoxetine" is silly because Prozac affects people in different ways. It worked dreadfully for me, yet others are perfectly happy with it.
I suppose the reason SJW isn't prescribed/suggested to everyone above traditional ADs is that it's simply not suitable for every case of mental illness, and interacts with other medications. That's why your doctor will look at your symptoms and suggest the most suitable AD they believe is available. No conspiracy. Else we'd all be on the same thing, right?
I'm happy that you're feeling brighter and have found something that works for you, though! : )

[KissesBreakingWave]

Same experience as Ignaz with sertraline. Didn't do bugger all as far as I could tell.

As for the drug companies not making money of St. John's Wort, that's nonsense. It's the drug companies that make all the pills that the herbal remedies are sold in. They love that stuff: no regulatory approval, no testing regime, no wondering if the patent can be engineered around, and the cost of production is negligible compared with the cost of bulk synthesis of a complicated molecule.


And for the homeopathic stuff, it doesn't even have to have any actual effects!

[ouryve]

The sheer dishonesty behind the clinical testing of SSRIs, aside, when a "new" drug is prescribed, reported side effects are recorded via the yellow card system. So, the list of side effects and possible side effects (ie odd thing that happened, while taking the medicine, whether the medicine was the cause or not) for many prescription medications is long. The simple low dose tricyclic that enables me to sleep despite pain has a comparable list to the one posted. It works wonders, though, but no way would I want to take it at an antidepressant dose.

[KissesBreakingWave]

Oh, and I tried SJW as well before trying the ADs. Had it growing in my garden at the time. Didn't make any difference to me. (As it turns out, depression was a symptom of something else, so I'm kind of lucky I didn't go completely doolally on it or any of the other SSRIs I took.)